The Role of Brain Computed Tomography in Evaluating Children with New Onset of Seizures in the Emergency Department

Authors

  • Joseph Maytal,

    Corresponding author
    1. Division of Pediatric Neurology, Schneider Children's Hospital, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York, U.S.A.
    Search for more papers by this author
  • Joel M. Krauss,

    1. Division of Pediatric Neurology, Schneider Children's Hospital, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York, U.S.A.
    Search for more papers by this author
  • Gerald Novak,

    1. Division of Pediatric Neurology, Schneider Children's Hospital, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York, U.S.A.
    Search for more papers by this author
  • Joy Nagelberg,

    1. Pediatric Emergency Department, Schneider Children's Hospital, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York, U.S.A.
    Search for more papers by this author
  • Mahindra Patel

    1. Department of Radiology, Long Island Jewish Medical Center, The Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York, U.S.A.
    Search for more papers by this author

  • Presented in part at the International Child Neurology Congress, Slovenia, 1998.

Address correspondence and reprint requests to Dr. Joseph Maytal, Division of Pediatric Neurology, Schneider Children's Hospital, Long Island Jewish Hospital, New Hyde Park, NY 11040, U.S.A.

Abstract

Summary: Background: The purpose of neuroimaging of a patient with new onset of seizures is to demonstrate cause and explore the prognosis. It was recently recommended that emergency brain computed tomography (CT) be performed only in adult seizure patients with an increased likelihood of life-threatening lesions, i.e., those with new focal deficits, persistent altered mental status, fever, recent trauma, persistent headaches, history of cancer, history of anticoagulation, or suspicion of acquired immunodeficiency syndrome. The objective of this study was to determine the diagnostic utility of emergency brain CT in children who present to the emergency department with new onset of seizures.

Methods: A 1-year retrospective chart review of all children who presented to the emergency department of the Schneider Children's Hospital with a new onset of seizures and who underwent CT of the brain, excluding children with simple febrile seizures.

Results: Sixty-six patients, 34 boys and 32 girls with a mean age of 4.9 years, qualified for inclusion in the study. Fifty-two patients (78.8%) had normal CT results and 14 patients (21.2%) had abnormal CT results. Seizure cause was considered cryptogenic in 33 patients, of whom 2 (6%) had abnormal CT results; neither patient required intervention. Seizure cause was considered symptomatic in 20 patients, of whom 12 (60%) had abnormal CT results (p < 0.0001). In two patients with abnormal CT scans (both acute symptomatic), the imaging findings were of immediate therapeutic significance and were predictable from the clinical history and the physcial examination. None of the 13 patients with complex febrile seizure cause had an abnormal CT scan. Patients with partial convulsive seizures were more likely to have abnormal CT scans than patients with generalized convulsive seizures, but the difference was not statistically significant.

Conclusions: The routine practice in many pediatric emergency Department of obtaining brain CT scans for all patients with new onset of nonfebrile seizures is unjustified. History and physical examination are sufficient to identify those patients for whom such studies are likely to be appropriate. Emergent CT is not indicated for patients with no known seizure risk factors, normal neurological examinations, no acute symptomatic cause other than fever, and reliable neurological follow-up. For these patients, referral to a pediatric neurologist for further workup, including electroencephalography and the more diagnostically valuable magnetic resonance imaging, would be more appropriate.

Ancillary